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Barreto MGP, Silva C, Barreto RP, Barreto RP, de Vasconcelos LMT, Manso MC. Determinants of Neonatal and Postneonatal Mortality in Northeastern Brazil: A Cohort Study of Newborns Admitted to the Neonatal Intensive Care Unit. Healthcare (Basel) 2024; 12:1249. [PMID: 38998784 PMCID: PMC11241063 DOI: 10.3390/healthcare12131249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
Despite advances in neonatology, neonatal mortality from preventable causes remains high in the North and Northeast regions of Brazil. This study aimed to analyze the determinants associated with neonatal and postneonatal mortality in newborns admitted to a neonatal intensive care unit. A cohort study was carried out in a capital in the Brazilian Northeast from 2013 to 2018. The outcome studied was death. Poisson regression was performed in the multivariate analysis of variables. Four hundred and eighty newborns were eligible, and 8.1% (39 newborns) died. Among them, 34 died in the neonatal period. The determinants that remained significantly associated with neonatal and postneonatal mortality in the final adjustment model (p < 0.05) were history of abortion, perinatal asphyxia, early neonatal sepsis and umbilical venous catheterization. All causes of this outcome were preventable. The neonatal mortality rate, although it did not include twins, neonates with malformations incompatible with life and other conditions, was 3.47 deaths per thousand live births (95% CI:1.10-8.03‱), well below the national average. In this study, pregnant women from different social classes had in common a private plan for direct access to health services, which provided them with excellent care throughout pregnancy and postnatal care. These results indicate that reducing neonatal mortality is possible through public policies with strategies that promote improvements in access to health services.
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Affiliation(s)
- Maria Goretti Policarpo Barreto
- Faculdade de Ciências e Tecnologia Universidade Fernando Pessoa, Praça 9 de Abril 349, 4249-004 Porto, Portugal
- Hospital Regional Unimed Fortaleza (HRU), Avenida Visconde do Rio Branco, 400, São João do Tauape, Fortaleza 60420-570, CE, Brazil; (R.P.B.); (R.P.B.); (L.M.T.d.V.)
| | - Cláudia Silva
- Faculdade de Ciências da Saúde, RISE-Health, Universidade Fernando Pessoa, Rua Carlos da Maia, 296, 4200-150 Porto, Portugal;
- FP-I3ID, FP-BHS, Universidade Fernando Pessoa, Praça de 9 de Abril 349, 4249-004 Porto, Portugal
| | - Renata Policarpo Barreto
- Hospital Regional Unimed Fortaleza (HRU), Avenida Visconde do Rio Branco, 400, São João do Tauape, Fortaleza 60420-570, CE, Brazil; (R.P.B.); (R.P.B.); (L.M.T.d.V.)
- Centro de Ciências da Saúde, Universidade de Fortaleza (UNIFOR), Avenida Washington Soares, 1321, Edson Queiroz, Fortaleza 60811-905, CE, Brazil
| | - Roberta Policarpo Barreto
- Hospital Regional Unimed Fortaleza (HRU), Avenida Visconde do Rio Branco, 400, São João do Tauape, Fortaleza 60420-570, CE, Brazil; (R.P.B.); (R.P.B.); (L.M.T.d.V.)
- Centro de Ciências da Saúde, Universidade Federal do Ceará (UFC), Avenida da Universidade, 2853, Benfica, Fortaleza 60020-181, CE, Brazil
| | - Lara Moreira Teles de Vasconcelos
- Hospital Regional Unimed Fortaleza (HRU), Avenida Visconde do Rio Branco, 400, São João do Tauape, Fortaleza 60420-570, CE, Brazil; (R.P.B.); (R.P.B.); (L.M.T.d.V.)
- Centro de Ciências da Saúde, Universidade de Fortaleza (UNIFOR), Avenida Washington Soares, 1321, Edson Queiroz, Fortaleza 60811-905, CE, Brazil
| | - Maria Conceição Manso
- Faculdade de Ciências da Saúde, RISE-Health, Universidade Fernando Pessoa, Rua Carlos da Maia, 296, 4200-150 Porto, Portugal;
- FP-I3ID, FP-BHS, Universidade Fernando Pessoa, Praça de 9 de Abril 349, 4249-004 Porto, Portugal
- REQUIMTE-LAQV (Laboratório Associado de Química Verde), Universidade do Porto, 4050-313 Porto, Portugal
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Neri DT, da Costa Miranda AL, Botelho EP, Valois RC, Dias GAR, Parente AT, da Cunha Araújo E, Ferreira GRON. Hospitalizations for congenital syphilis in children under one year old in the state of Pará, Brazilian Amazon: ecological study. BMC Pediatr 2023; 23:581. [PMID: 37986154 PMCID: PMC10658822 DOI: 10.1186/s12887-023-04409-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND The high incidence of congenital syphilis shows flaws in the resolution of primary health care, being a predictor of greater use of hospital services, whose regional differences in access to health actions and services may be reflected in health inequalities. OBJECTIVE to investigate hospitalizations due to congenital syphilis in children under one year of age, in the state of Pará, Brazilian Amazon. METHODS an ecological study was carried out, using hospitalization, lethality and mortality rates related to congenital syphilis in children under one year of age. Temporal analysis and mapping of hospitalization flows were carried out using Joinpoint®, version 4.7.0.0, Terraview 4.2.2, Tabwin 4.1.5. RESULTS A total of 6,487 hospitalizations were recorded. For the ten years of the study period (2009 to 2018), the lethality rate showed a decreasing trend of - 13.5% (p = 0.01). The crude hospitalization rate showed an increasing trend of 12.8% (p < 0.000. The regression analysis demonstrated that there was a change point in the trend with a significant growth of 12.8% until 2016 (p = 0.0006). In the mortality rate the trend was stable (p = 0.56). The analysis of hospitalization care flows made it possible to identify that most hospitalizations due to congenital syphilis occurred in the municipalities of residence, but 1,378 (21.2%) had to move. Two large care gaps were highlighted in Metropolitan health regions II and III, belonging to macroregion II. The hospitalizations of residents of these regions were carried out by the assistance networks of Belém (capital) and Marituba, both of which are part of Metropolitana I. Residents of macroregions III and IV had the greatest distances traveled to access hospital care. CONCLUSIONS The increase in the rate of hospitalizations with an increasing trend demonstrates the impact that syphilis still causes in Brazil, not being resolved even after national government interventions in primary health care, but there was a decreasing trend in the fatality rate. The results demonstrate a heterogeneous organization of health care networks in the state's health regions and macroregions.
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Affiliation(s)
- Débora Talitha Neri
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, 66075-110, Belém, PA, Brazil
| | - Amanda Loyse da Costa Miranda
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, 66075-110, Belém, PA, Brazil
| | - Eliã Pinheiro Botelho
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, 66075-110, Belém, PA, Brazil
| | | | - Geyse Aline Rodrigues Dias
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, 66075-110, Belém, PA, Brazil
| | - Andressa Tavares Parente
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, 66075-110, Belém, PA, Brazil
| | - Eliete da Cunha Araújo
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, 66075-110, Belém, PA, Brazil
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Quality of the home, daycare and neighborhood environment and the cognitive development of economically disadvantaged children in early childhood: A mediation analysis. Infant Behav Dev 2021; 64:101619. [PMID: 34385051 DOI: 10.1016/j.infbeh.2021.101619] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/20/2021] [Accepted: 07/24/2021] [Indexed: 11/20/2022]
Abstract
The objective of this study was to investigate how socioeconomic factors and the quality of ecological environments affect motor and cognitive development of economically disadvantaged children. This is a cross-sectional, predictive and correlational study using structural equation modeling to analyze data on 147 economic disadvantage children of 24-36 months attending public daycare. The Bayley-III Scales, the Home Observation for Measurement of the Environment Inventory, the Infant/Toddler Environment Rating Scale-Revised Edition, a socioeconomic index and a specifically designed questionnaire on neighborhood quality were applied. The ecological environments did not affect motor development, but 25 % of variations in cognitive development were explained by socioeconomic differences and differences in the quality of the neighborhood, home and daycare. However, only the quality of the home and daycare had a direct impact, with the other factors affecting the outcome indirectly and to a lesser extent. In conclusion, this study investigated the association between the ecological contexts of economically disadvantaged children and their cognitive and motor development. The findings showed that the environmental context had effect on cognitive development. The home was the environment that exerted the most significant direct effect, followed by daycare and, indirectly and to a lesser extent, the neighborhood. Therefore, the coordination of public policies between health, education and social assistance sectors, aiming at the three ecological environments is important in order to promote the cognitive development of economically disadvantaged children.
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França KEXD, Vilela MBR, Frias PGD, Sarinho SW. EARLY NEONATAL NEAR MISS IN A UNIVERSITY HOSPITAL: COMPARATIVE CROSS-SECTIONAL STUDY. ACTA ACUST UNITED AC 2020; 39:e2019317. [PMID: 32996995 PMCID: PMC7518722 DOI: 10.1590/1984-0462/2021/39/2019317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/05/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare 2012 and 2016 data on early neonatal near miss indicators from Health Information Systems at a university hospital. METHODS This is a cross-sectional study conducted in 2012 and 2016. We considered early neonatal near misses the live births that presented one of the following risk conditions at birth: gestational age <33 weeks, birth weight <1,750g or 5-minute Apgar score <7, or Neonatal Intensive Care Unit (NICU) admission, and were alive until the 7th day of life. Data were collected from the Live Birth Information System, Hospital Information System, and Mortality Information System. We calculated the early neonatal mortality rate, neonatal near miss rate, severe neonatal outcome rate, early neonatal survival index, and early neonatal mortality index, compared by year of birth. RESULTS In 2012, 304 early neonatal near misses were registered, with a higher proportion of cases with very low birth weight and mothers who had zero to three prenatal visits. In 2016, the number of cases was 243, with a predominance of more NICU admissions. The incidence of early neonatal deaths and early neonatal near misses was higher in 2012 than in 2016. CONCLUSIONS Neonatal near miss indicators identified difference between years. The cases were more severe in 2012 and there were more NICU admissions in 2016.
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Costa MDFDS, Magluta C, Gomes Junior SCDS. [Profile of service providers in high-risk neonatal care in the databases of the Brazilian Unified National Health System]. CAD SAUDE PUBLICA 2020; 36:e00219618. [PMID: 32267387 DOI: 10.1590/0102-311x00219618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 09/23/2019] [Indexed: 11/22/2022] Open
Abstract
The study aimed to analyze the profile of service providers in the Brazilian Unified National Health System (SUS) in relation to high-risk neonatal care procedures, based on data from the public-access database on Authorizations for Hospital Admissions (AIH) without identification of the neonatal patient. This cross-sectional study used data on AIH of unidentified newborns up to one day old, issued from January 2013 to December 2015, and from the National Registry of Healthcare Establishments. The TwoStep Cluster method was used to classify the establishments with similar characteristics. Regional differences were observed in the frequency of use of neonatal intensive care units and in special procedures recorded in the databases. The TwoStep Cluster method identified three groupings of providers: the first with 1,151 establishments and with low-complexity hospitalizations, the second with 84 establishments and surgical-profile hospitalizations, and the third with 393 establishments and higher complexity hospitalizations in neonatal care, including surgeries. The records on admissions jointly with multivariate analytical techniques have the potential to support decision-making by SUS administrators in the organization of neonatal care.
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Affiliation(s)
- Maria de Fatima Dos Santos Costa
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Cynthia Magluta
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Mendes RB, Santos JMDJ, Prado DS, Gurgel RQ, Bezerra FD, Gurgel RQ. Maternal characteristics and type of prenatal care associated with peregrination before childbirth. Rev Saude Publica 2019; 53:S0034-89102019000100258. [PMID: 31432932 PMCID: PMC6705547 DOI: 10.11606/s1518-8787.2019053001087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 11/06/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyze the maternal characteristics and type of prenatal care associated with peregrination before childbirth among pregnant women in a northeastern Brazilian state. METHODS Quantitative and transversal study, with descriptive and analytical approaches, part of the Nascer em Sergipe research held between June 2015 and April 2016. A total of 768 puerperal women proportionally distributed across all maternities of the state (n = 11) were evaluated. Data were collected in interviews and from prenatal records. The associations between antepartum peregrination and the exposure variables were described in absolute and relative frequencies, crude and adjusted odds ratios and their respective confidence intervals. RESULTS Antepartum peregrination was reported by 29.4% (n = 226) of the interviewees, most of whom sought care in a single service before the current one (87.6%; n = 198). It should be noted that antepartum peregrination was less frequent among women aged ≥ 20 years old (OR = 0.50; 95%CI 0.34–0.71), with high education level (OR = 0.42; 95%CI 0.31–0.59) and a paid job (adjusted OR = 0.59; 95%CI 0.41–0.82), who had been instructed during prenatal care about the referral maternity for childbirth (adjusted OR = 0.88; 95%CI 0.42–0.92), and who used the private service to receive prenatal (adjusted OR = 0.44; 95%CI 0.18–0.86) or childbirth (adjusted OR = 0.96; 95%CI 0.66–0.98) care. No statistical evidence of associations between gestational characteristics and the occurrence of peregrination was observed. CONCLUSIONS Antepartum peregrination suffers interference from the mother’s socioeconomic characteristics, the type of prenatal care received and the source of funding for childbirth.
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Affiliation(s)
| | - José Marcos de Jesus Santos
- Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Programa de Pós-Graduação Enfermagem em Saúde Pública. Ribeirão Preto, SP, Brasil
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